Predictors of Glycemic Response and Change in HbA1c Following Newly Initiated Basal Insulin Among Insulin Naïve Adults With Type 2 Diabetes

This sub-analysis of the Iran-AFECT study was to determine the baseline characteristics are predicting the likelihood of attainment of HbA1c goal and changing in HbA1c after initiation of basal insulin glargine in insulin naïve people with type 2 diabetes not adequately controlled with oral glucose-lowering drugs. Iran-AFECT was a 24-week, prospective, multicenter, observational study of people with type 2 diabetes initiated or switched to insulin glargine. In this sub-analysis, we included all insulin naïve people. Glycemic response was defined as HbA1c≤7.0% and/or change in HbA1c at week 24. Data on 433 participants were included. The mean HbA1c was 8.9%±0.9% at baseline which decreased to 7.6%±1.2% (P<0.001). By week 24, 36% of the participants reached HbA1c≤7.0%. In univariate analysis, the strongest association was for the baseline HbA1c (r2=0.32, P<0.001). In multivariate analysis, predictors of change in HbA1c were baseline HbA1c (r2=0.29, P<0.001), and dosing of glargine (r2=0.01, P=0.02). The baseline HbA1c was accounting for 88% of explainable variances in HbA1c. The best cut-off predicting glycemic response for baseline HbA1c was 8.5%. Among factors predicting response to initiating basal insulin therapy with insulin glargine, baseline HbA1c is the strongest predictor explaining most of the variances in HbA1c change

The challenge of living with diabetes in women and younger adults : A structural equation model

Background: Attitudes toward diabetes care are different between genders and age-groups. Furthermore, diabetes related challenges may cause psychosocial problems. Therefore, we were to compare the psychosocial status and glycemic control in women and men with type 2 diabetes (T2D) in different age-groups. Methods: 441 adults with T2D were recruited. Demographic, self-care behavior, resources and affective variables as well as the health related quality of life (HRQoL) were measured. The median age of 55 was used as the cut-off for the age comparison. Structured equation modeling (SEM) investigated the relationship between age, gender, psychosocial factors and glycemic control. Results: Finally, 203 women and 177 men completed the study (86.1%). There was no significant difference in mean duration of T2D, or glycemic control between genders or age-groups. Women, especially those below the median age of 55, had significantly higher level of diabetes-related distress (2.16. ±. 0.94 vs. 1.92. ±. 0.81), depression (9.67. ±. 5.37 vs. 7.54. ±. 5.06), and anxiety (19.81. ±. 12.04 vs. 12.81. ±. 9.04, P. <. 0.05 for all comparisons), while people above the age of 55 reported better self-management and patient-physician relationship. HRQoL was lower in women compared to men (0.77. ±. 0.23 vs. 0.81. ±. 0.18, P = 0.02). The final SEM suggested that the effect (standardized β coefficient) of gender and age on affective variables was 0.25 and -0.19 (P. <. 0.05), respectively, though psychosocial factors did not directly influence HbA1c. Conclusions: This study shows that psychosocial factors are associated with age and gender in patients with T2D; with younger women demonstrating higher level of depressive symptoms, anxiety, and diabetes-related distress independent of status of glycemic control

Psychosocial factors and glycemic control in insulin-naïve and insulin-experienced people with type 2 diabetes : a path analysis model

The purpose of this study was to compare the status of psychosocial factors and glycemic control in insulin-naïve and insulin-experienced people with type 2 diabetes (T2D). In this observational study on people with T2D, demographic, self-care behavior, resources, and affective variables as well as health-related quality of life were assessed and compared in insulin-naïve and insulin-experienced considering the number of oral glucose-lowering drugs (OGLDs). Measured variable path analysis was used to test the association among variables and their effect on HbA1c in both groups. In total, 215 insulin-naïve and 165 insulin-experienced patients were recruited in this study. The mean duration of diabetes was 11.7 ± 7.0 years in insulin-experienced and 6.8 ± 5.4 years in insulin-naïve (p < 0.001). The mean hemoglobin A1c (HbA1c) was significantly higher in insulin-experienced subjects irrespective of the number of OGLDs [68 ± 20 mmol/mol (8.4 ± 1.8%) vs. 56 ± 16 mmol/mol (7.3 ± 1.4%); p < 0.001]. Moreover, insulin-experienced subjects had significantly higher level of diabetes-related distress (2.2 ± 0.9 vs. 1.9 ± 0.8), depression (9.5 ± 5.5 vs. 8.1 ± 5.1), anxiety (18.3 ± 12.0 vs. 15.1 ± 10.5), and lower knowledge of insulin use considering the results of 9-item insulin-use subscale of Michigan diabetes knowledge test (mean 3.9 ± 1.8) compared to insulin-naïve subjects (p < 0.05). Higher levels of distress, depression, and anxiety are found in insulin-experienced people with T2D. Therefore, one should be aware that, at the time of insulin need/initiation, people with T2D have reached a more vulnerable state and this should be taken into consideration when implementing a complex insulin initiation plan

The association between the number of office visits and the control of cardiovascular risk factors in Iranian patients with type2 diabetes

<div><p>Introduction</p><p>Patients with diabetes type2 should receive regular medical care. We aimed at investigating the association between the number of office visits and improvement of their cardiovascular-risk factors.</p><p>Methods</p><p>Four hundred and ninety patients with type 2 diabetes mellitus who were followed in a tertiary center were enrolled in this longitudinal study. The minimum follow up period was 3 years. Patient data were extracted from manual or electronic records.</p><p>Results</p><p>Sixty- four percent of cases were females, the mean age was 61 ± 12.45 years, and the mean disease duration was 6.5 ±7.9 years. The mean number of office visits was 2.69 ± 0.91 per year. Comparing the means of each of the cardio-vascular risk factors showed a significant decrease in all cardiovascular risk factors, while there was a significant weight gain over the same period. The association between changes in these parameters and the number of patients’ office visits per year were not statistically significant. In patients with disease duration less than 5 years, each additional office visits by one visit per year was associated with a decrease in serum total cholesterol by 6.94 mg/dl. The mean number of office visits per year in patients older than 60 years old was more than younger patient (p = 0.001).</p><p>Conclusion</p><p>The decrease in the mean values of the investigated parameters was statistically significant between the first year of follow up and the following years. Yet, these changes were not related to the mean number of patients’ office visits per year, which may reflect the poor compliance of patients to treatment regardless of the number of their office visits.</p></div

The number of patients who achieved the ADA 2015 goal for each of the investigated parameters (blood pressure, LDL, HbA1c, FBS, 2hpp glucose).

<p>The number of patients who achieved the ADA 2015 goal for each of the investigated parameters (blood pressure, LDL, HbA1c, FBS, 2hpp glucose).</p

Linear relationship between changes in cardiovascular risk factors and mean number of visit per year.

<p>Linear relationship between changes in cardiovascular risk factors and mean number of visit per year.</p

Basal characteristics of patients.

<p>Basal characteristics of patients.</p

Binary logistic regression between goal outcomes^* and mean number of visit per year, adjusted by sex and age.

<p>Binary logistic regression between goal outcomes^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0179190#t004fn002" target="_blank">*</a>} and mean number of visit per year, adjusted by sex and age.</p

Linear relationship between mean of individual's cardiovascular risk factors and mean number of visit per year.

<p>Linear relationship between mean of individual's cardiovascular risk factors and mean number of visit per year.</p

The mean values for the investigated variables in the first year compared to the following years.

<p>The mean values for the investigated variables in the first year compared to the following years.</p